New study determines management of training load key to injury prevention in elite rugby

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A World Rugby-commissioned study examining the management of game and training load by elite players has provided recommendations that will further inform player management and injury-prevention strategies for the elite game.

Published in the British Journal of Sports Medicine, and called ‘Managing player load in professional rugby union: a review of current knowledge and practices’, the study reflects World Rugby’s ongoing evidence-based commitment to injury prevention at all levels of the game. It was undertaken by a cross-discipline working group as an action from World Rugby’s annual medical conference.

The first study of its kind, this in-depth review of current practices and literature examined the loads (activity levels) encountered by professional rugby players, and was designed to better understand the impact on physical and mental health with the end goal of determining potential recommendations for injury prevention.

The expert group examined the playing, training (individual and team), travel and other time commitments experienced by more than 2300 players across the 2013-14 domestic and international seasons.

The data confirmed:

*   40 per cent of professional players played in 20 matches or more, but only 5 per cent of players were involved in 30 matches or more
*   The average match minutes played by players across the season was 852 minutes and is equivalent to playing 10.7 full matches
*   On average for elite players, matches account for 5-11 per cent of total exposure (playing, team and individual training time), but account for 70-75 per cent of injuries sustained
*   Players rated match load as 15-27 per cent of the total load in terms of effort expended
*   Players sustain at least one injury requiring time off from training or play per season, highlighting the continued need to enhance injury-reduction strategies in the playing environment

The working group identified the most common factors behind increased risk of injury and noted these should be considered in any injury prevention strategy:

*   Players entering a new level of competition are more susceptible to injury
*   Sudden changes in training frequency, intensity, time or type can impact on injuries
*   Players returning from injury or unresolved previous injuries are at a higher risk of injury
*   Players who have little training and playing exposure may be at a higher risk of injury owing to a lack of conditioning
*   Players with very high exposure to training and playing exposure may become more susceptible to acute and gradual injuries owing to physical and mental fatigue

It was highlighted that if the total load is a risk factor for injury, then load management should primarily focus on training. The group recommended the following actions be considered by administrators, tournament organisers, coaches and teams:

*   Coaches/team personnel look closely at managing load via planning and adapting training sessions and clear communication regarding short and long term load monitoring and management goals
*   Caution is advised when incorporating sudden changes in frequency, intensity and type of training, including during pre-season, season and breaks in competition
*   Loads should be individually managed. Some players may be at higher risk of injury such as players returning from injury, inexperienced players or those who have taken a step-up in competition level. Further research is recommended to quantify the extent to which these risk factors impact on injury
*   Monitoring should also include non-rugby activities, and further research is required in the areas of air travel and other obligations to assess the impact on injury risk

World Rugby Chief Medical Officer Dr Martin Raftery said: “As the global governing body, World Rugby is committed to supporting further research in this area with the objective of furthering our injury-prevention strategies at all levels of the game.

“Training and playing loads are known to impact on injury rates, with increased overall loads leading to fatigue. Players should be managed on an individual basis as the data suggests players returning from injury and players exposed to sudden changes in training appear to be at a higher risk of injury.

“This data will assist with a holistic approach to injury prevention, furthering understanding and adding context for coaches and medics. While the data suggests that neither the incidence or severity of injuries is increasing, we continue to prioritise research that will further injury-prevention within the sport.

“In addition, World Rugby is currently nearing the end of an unprecedented study of the mechanics and causes of Head Injury Assessment events in more than 1500 matches.”

England and British and Irish Lions prop Alex Corbisiero, who was on the working group, welcomed the findings as an important step forward in understanding and managing loads that elite players are subjected to.

“At a player level, we are always striving to perform at our best on a consistent basis, and the outcome of this study, we hope, will promote increased understanding and collaboration with team support staff who are also striving to prevent injury and optimise our performance.”

Dr Ken Quarrie, the lead author of the review, commented that the breadth and depth of knowledge brought to the project by the cross-disciplinary team was a strength of the paper:  “We had 15 experts from nine different countries, with a wide variety of backgrounds, all of whom brought real value to the project. The research team included experts in sport psychology, load management in contact sports, injury epidemiology, rugby medicine, and the physical demands of international rugby. Being able to call upon people with practical and academic experience in managing loads, in addition to current and ex-players was invaluable. This cross-section of experts provided real-world examples of the pressures players face.”

 

The research team included experts in sport psychology, load management in contact sports, injury epidemiology, rugby medicine, and the physical demands of international rugby: Dr Ken Quarrie (lead author); Dr Martin Raftery; Josh Blackie; Chris Cook; Colin Fuller, Tim Gabbett, Andrew Gray, Nicholas Gill, Liam Hennessy, Simon Kemp, Mike Lambert, Rob Nichol, Stephen Mellalieu, Julien Piscione, Jörg Stadelmann; Ross Tucker and former England player Alex Corbisiero.

World Rugby operates an evidence-based approach in its commitment to furthering player welfare at all levels of the game and guided by independent experts, and has introduced numerous and wide-ranging interventions that are proving to enhance the protection of players.

  • RWC 2015 player welfare standards (http://www.worldrugby.org/news/79919) operational across World Rugby competitions and now adopted by other major event owners
  • Innovative head injury assessment software standardising reporting and assessment process, made available across the international game by World Rugby and partner CSx
  • Dedicated independent concussion advisory group, advising World Rugby on concussion strategy
  • Dedicated Multi-disciplinary injury-prevention group, advising World Rugby on injury prevention
  • World Rugby concussion educational guidelines viewed as sporting best practice and used across football, hockey and cross-sport in Scotland
  • Dedicated #RecogniseAndRemove concussion App launched in October 2015 with 1,800 completions to date
  • Mandatory concussion education across World Rugby training and education, Rugby Ready and medical courses
  • Mandatory concussion education for players, medics and coaching staff across all World Rugby 15s and sevens tournaments, including Rugby World Cup with more than 17,000 completions in 2015
  • Six concussion modules included within the World Rugby Tournaments Player Welfare
  • Standards programme operating at all World Rugby tournaments and other major rugby events (inc mandatory education, baseline testing, incident review, power of independent doctor to remove)
  • Head Injury Assessment (HIA) proving successful in the identification and removal of suspected concussion in elite rugby
  • Graduated Return to Play protocols implemented in 2012
  • Introduction of Hawk-Eye technology for incident identification and assessment at Rugby World Cup 2015Independent concussion experts advising on playing return following Graduated Return to Play completion at Rugby World Cup 2015

World Rugby will join other international sporting federations and leading independent experts to participate in the fifth International Consensus Conference on Concussion in Sport in Berlin this weekend and the IOC conference on injury and illness prevention in sport in March, underscoring rugby’s commitment to cross-sport collaboration and standards and is designed to review and standardise on-field concussion management in sport.

Further information regarding World Rugby’s player welfare approach can be found at playerwelfare.worldrugby.org

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